Bring in an article in the news (hand in a copy) that discusses a child welfare or family policy issue and write about it. In your paper:
1. Summarized the policy discussion
2. State the problem underlying the policy
3. How does the policy fit with social work values?
4. How does the policy relate to child welfare or families?
5. What is the policy’s successes? What is its failures?
6. What is your own opinion on what advocacy should look like on this issue?
Papers should be between 3 and 5 pages in length.
California doctors, insurers face off over reimbursement rates
By Tracy
Seipel
Posted: 02/23/2014
01:39:31 PM PST
Updated: 02/24/2014
05:56:22 AM PST
Lowering
costs by forcing doctors and insurers to compete for millions of new patients
is a primary goal of the nation's new health care law, but a group of
gastroenterologists in the East Bay and internists near Chico are exposing a
fissure in that plan.
There
often aren't enough doctors to go around.
In
parts of the state, the shortage of doctors participating in California's new
insurance exchange is providing new leverage for medical providers to hold out
for higher reimbursement rates from big insurance companies. And as a game of
chicken unfolds behind the scenes between two powerful groups that are key to
the law's success, the insurers are often caving in to the doctors, raising
concerns that the trend could catch on and drive up the price of health
insurance premiums on the exchange.
Medical
costs are the largest component of a health insurance premium, said Darrel Ng,
a spokesman for Anthem Blue Cross of California. And the higher those costs go,
he said, "the higher the premium will likely be on the exchange in the
future."
Many
doctors are upset about the discounted reimbursement rates that insurers have
imposed on them to keep premiums low on the Covered California exchange. The
new rates -- as much as 30 percent lower than those paid by nonexchange plans
-- took effect Jan. 1, when the new health care plans of hundreds of thousands
of Californians kicked in.
The
number of doctors who have had their old rates restored is still small compared
to the 58,000 physicians that Covered California says are participating in the
new marketplace.
Whether
these side deals will ultimately raise rates on the new exchange isn't clear
yet. But health care experts wonder what the trend portends for the success of
the law, which depends on attracting hordes of consumers to lower-priced insurance
policies.
As
more people sign up for the expanded Medi-Cal program and private plans on the
exchange, "there will be a surge in the demand for doctors," said
Glenn Melnick, a health economist at the University of Southern California.
But
because there's a fixed supply of physicians, he predicted, many doctors will
be able to tell the insurers: "Wait a second. You delivered us a promise,
and I'm busier than ever, and you need me. But I don't need to agree to a
discount anymore."
Central
to the standoff are state regulations that require insurers to provide their
customers access to primary care physicians within 15 miles or 30 minutes of
their homes. Plans also are required to have a primary care
physician-to-patient ratio of 1 to 2,000, and an overall physician-to-patient
ratio of 1 to 1,200. If for some reason the health plan does not have a
particular type of specialist, the plan must find such a provider.
In
many cases, the winners in the doctor-insurer faceoff are physicians in rural
regions, where health care services are scarce. But the table-turning has also
surfaced in the Bay Area and other metropolitan regions.
"Most
doctors want to take care of patients," said Dr. Richard Thorp, president
of the California Medical Association, a lobbying group that represents about
40,000 of the state's 104,000 licensed physicians. He's also an internist who
belongs to a 12-member group practice in Paradise, near Chico, that was able to
reinstate its old fees with Blue Shield of California.
"But
they have to make an individual choice based on whether they can afford to
service those contracts," Thorp said. "That is the reality."
Blue
Shield and Anthem Blue Cross, two of the four largest insurers offering Covered
California plans, acknowledged that they are reinstating some old rates.
Blue
Shield spokesman Steve Shivinsky said the insurer has restored rates for 1,400
California physicians, many of whom practice in rural areas, to ensure adequate
medical care is available. Yet he said that's still "a tiny fraction"
of the majority of its 35,000 network physicians who signed new contracts to
participate and agreed to accept discounted rates in exchange for more patient
volume.
Dr.
Mark Kogan, a San Pablo gastroenterologist, is one of the physicians who used
the law of supply and demand to make the case for higher rates.
Along
with 18 colleagues at Northern California Gastroenterology Consultants, he
already sees plenty of patients. So when Blue Shield last year offered the
group more business from new Covered California enrollees -- but at 30 percent
less -- the group declined.
"We
basically told them, 'We cannot do that,' " Kogan recalled. "We would
lose money by seeing those patients."
That
put Blue Shield in a bind. Without access to those 19 gastroenterologists who work
out of seven East Bay offices, where would its subscribers go?
By
mid-January, Blue Shield backed down and agreed to pay the group of specialists
its current rates if the doctors would take on the insurer's exchange patients.
The
issue of discounted fees surfaced at Thursday's Covered California board
meeting after Kim Griffin, chairwoman of Medical Office Managers of the
Peninsula, told the board in a letter that because some insurers are
discounting fees for exchange customers, "many of us have opted out."
That
doesn't surprise Thorp and Kogan, who say there is a misconception among the
public that access to more patients means more money.
"If
you are pricing a service for less than it costs you to provide it," Thorp
said, "you cannot make that up in volume."
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